Technology as a Tool to Engage Employees and Save Lives in India

India has made impressive strides in reducing its child mortality rate in the last four decades. Much work remains to be done, however, as India still loses too many children to diseases that can be easily prevented. Of the 26 million Indian children born annually, 1.83 million die before they reach age five. And for India’s poor children, the odds are especially daunting with a child mortality rate three times higher than that of the rich.

Many of the reasons for these abysmal statistics are cultural. Women still prefer to give birth at home while superstitions over children’s care and food stubbornly persist. Logistics also present obstacles: health facilities are often too far away from India’s rural poor. Finally, India only spends four percent of GDP on health care, according to the World Bank; other estimates place that figure at a miserly one percent. Even if a woman lives near a public hospital, she often confronts overwhelmed medical professionals who show little tolerance for the poor or uneducated.

Now businesses are stepping in to fill in the gaps a dismissive government and overwhelmed NGOs cannot close. More companies, Indian and those based abroad, work with women at the “bottom of the pyramid” to deliver front line medical care to peers within their communities. India’s booming technology sector can enhance their duties. One mobile technology firm has become a model of how a business can deliver a product that inspires innovation, engages its employees and saves the lives of women and their children.

In 2010, Massachusetts-based Dimagi Software launched a search for partners in India to participate in the beta testing of its CommCare software, an open-source mobile platform containing checklists and educational prompts that assist health care workers to teach healthy behaviors. Catholic Relief Services (CRS), with Deepti Pant and her team, quickly responded. The charity had started to plan a mobile health clinic in the Kaushambi district of Uttar Pradesh, where 200 million people comprise India’s most populous, and among India’s poorest, states. Dimagi and CRS partnered to develop and refine a mobile health care phone application community health care workers can use when consulting with pregnant women and young children.

These women, Accredited Social Health Activists (ASHAs), are integral to health care services throughout India. With many of India’s poor either distrustful or unable to afford basic health care services, NGOs work with these women to distribute medicines, diagnose illnesses and deliver advice to women and children most vulnerable to a bevy of ailments from malnutrition to diarrhea. Organizations vet these women to participate in such health programs because they are trusted within their communities, serve as a vital point of contact and can communicate with their peers in ways doctors and nurses cannot. Most ASHAs are not salaried, but instead are compensated by incentives: for example, convincing a pregnant patient to give birth to her baby at a hospital instead of the home results in a bonus. In the case of CRS, mobile technology is the critical tool linking these women working in remote areas with medical professionals in regional health centers.

Young mother with child in a colony outside of Delhi

Leon Kaye

For CRS’ pilot ReMiND project (Reducing Maternal and Newborn Deaths), a phone app that was easy for low literate users to learn was crucial. ASHAs can gauge women’s and children’s health symptoms by showing a series of culturally-appropriate images paired with audio prompts recorded in each ASHA’s individual voice. This system is efficient because an ASHA can be trained in only 28 days. The application’s interface is in Hindi, and for the ASHAs, the system is far more intuitive and less cumbersome than traditional flip charts. Data from all the ASHAs’ phones is transmitted to a central server in Delhi, and medical professionals can quickly decide whether a hospital visit for a pregnant mother or sick child is necessary.

In my meeting with Ms. Pant in Mumbai earlier this year, she described the relationship between CRS and Dimagi as “symbiotic”: CRS led on content development and operations while Dimagi handled all of the technology issues. “Nonprofits and government can benefit from business’ expertise in reaching markets at scale,” she said, “as well as in leveraging technology and infrastructure for maximum benefit.”

The ReMiND project is a case study of how businesses and NGOs can collaborate and share best practices. Dimagi’s employees trained and mentored CRS’ IT staff in the building and maintenance of the CommCare platform to the point where CRS operates the system entirely on its own. Dimagi’s employees became invigorated by the opportunity to work on a project addressing India’s most dire health problems while boosting technical and professional skills. ASHAs are rewarded with a renewed purpose and enhanced stature within their communities and families. So far the program has proceeded smoothly, according to Ms Pant. CRS’ IT team can quickly resolve technology problems, mobile coverage in remote areas was better than expected and families and communities work with the ASHAs to ensure they could keep their phones charged–always a challenge when electricity shuts off for hours.

The ReMiND program wraps up in 2014 and CRS has already seen results. Final statistics are pending, but the improvement in ASHAs’ high-impact knowledge of prenatal and newborn care has risen 24 percent. ASHA’s have also reached over 2,700 pregnant women and over 45,000 family members and friends have received some form of health education from these workers. Ms Pant concludes that this program, leveraging few resources, could have a huge impact on child mortality if scaled. Annually, 6.3 million women in Uttar Pradesh who would otherwise lack any prenatal care could potentially benefit from such a program.